Comments for The Journal of Neurosurgery Podcast Archive

Comment on January 2009: Spinal Vascular Malformations by Christian

Christian — Sun, 05 Feb 2012 20:28:03 +0000

The goal of brain AVM tentamert is to protect the patient from a hemorrhagic event, neurological deficits and seizures and in the pediatric population to assure a normal psycho-motor development. Complete morphological cure of an AVM cannot always be achieved if these objectives are to be respected. This is particularly evident in children in whom a rapid anatomical (and not always clinical) cure has an elevated rate of morbidity and mortality, with some clinical consequences quantifiable only later in life. Partial targeted tentamert is, in my opinion, an acceptable alternative in the management of high risk AVMs (particularly large ones and/or those in eloquent locations). Planning for an endovascular intervention involves a methodological analysis of the lesion and of the patient’s clinical conditions, setting up short and long term goals and a careful evaluation of the risks of the endovascular approach alone or combined, if necessary, with surgery and/or radiotherapy. Additionally, there are probably some operator dependent variants during the procedures, but like in other surgical specialties our results need to be comparable and even standardized in order to be believable. The results of an intervention should not be related to the “good luck” of the operator (like W. Jan Van Rooij previously states) but with a pre-established strategy and the percentage of complications and eventual patient outcome that we, the neuroradiology community, are willing to accept as ethical in our practices and training programs.

Comment on Weekly Podcast by Yaya

Yaya — Sun, 05 Feb 2012 19:14:48 +0000

In the early years of AVM glue etimlizaboon, we worked to a hypothesis that maybe some complex AVMs could be completlely obliterated. Single pedicle small leasions were candidates, of course, also curable with excision. The few complex AVM cases that went on to complete obliteration days after a treatment had something in common – delayed outcome, and often low density or blood away from the nidus. It later made sense: to completely obliterate a mutli-pedicle complicated AVM, one needed to cause blockage of the main venous draiange, and the rest could clot. These were few and far between, without big bleeds ensuing.This brings up the glue versus ONYX. Is Onyx more likely to get the venous outlet and thereby produce complete obliteration? What about the risk of bleeding with venous outflow occlusions? Are there features of AVM venous drainage that we don’t know, but predispose to safe complete embolization? Rather than continuing the blind hope that a few of these cases will be completely obliterated, maybe there is place for vascular imaging study of the venous side of AVMs, seeking clues that predispose to this success. If the clues were known, maybe patients can be chosen for complete etimlizaboon as an intention rather than luck.

Comment on April 2009: Moyamoya Disease by Vi da

Vi da — Thu, 27 Oct 2011 09:36:01 +0000

I am a 40 year old female, in good mental and physical state of being. Recently I had two strokes at once and was hospitalized. I have also have von willebrand and lupus. While in the hospital undergoing several tests, on my medical report it implies possible unilateral moyamoya disease. What can I do to make sure I am in the right hands in the medical field? and that something like this does not get over looked, are there questions or concerns I should be asking these doctors? Your help would be greatly appreciated. Also the MRA had shown I have had multiple strokes prior to this last episode.

Comment on April 2009: Moyamoya Disease by Wanda Hunt

Wanda Hunt — Wed, 06 Apr 2011 13:10:20 +0000

Would love information on support groups and blogs on moyamoya. I was diagnosed on Christmas Day in 2010 after I suffered a stroke. Had another stroke on March 26, 2011.

Comment on April 2009: Moyamoya Disease by Moyamoya: Puff of Smoke « MarbleRoad’s Blog: Rare Diseases and Disorders; Public Health; and National Service

Thu, 09 Jul 2009 18:47:57 +0000

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